HEMATOLOGIC MANIFESTATIONS AND IMPAIRED LIVER SYNTHETIC FUNCTION DURING VALPROATE MONOTHERAPY

In a prospective study 50 children with new onset epilepsy were invest igated. Routine screening for complete blood count, serum protein, alb umin, gamma-glutamyltransferase (gamma-GT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and coag ulation studies before, 3, 6 and 9 weeks after commencement of antiepi leptic therapy with valproate were carried out. Serum B-12 and folate levels were also determined in 29 patients. The aim of the study was t o evaluate the effect of VPA on these laboratory findings. We found a significant reduction of red blood count and platelet count, whereas M CV showed a significant upward trend, Vitamin B,, levels were elevated after starting VPA therapy. We found no elevations of liver enzymes, but a significant transient reduction of ALT after 3 and 6 weeks and s ignificantly reduced serum protein and albumin after 3, 6 and 9 weeks. Coagulation studies revealed a significant downward trend in serum fi brinogen and upward trend in thrombin time. The other parameters showe d no significant changes after onset of VPA treatment. We think that r educed red blood cell and platelet counts, and elevated MCV indicate a direct toxic effect on a hematopoietic precursor or stem cell in pati ents treated with VPA. Furthermore, reduced protein, albumin and fibri nogen indicate an impaired liver synthetic function in asymptomatic ch ildren treated with VPA monotherapy.